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Tag: dementia

  • Concussions from Football Tied to Long-Term Cognitive Problems

    Concussions from Football Tied to Long-Term Cognitive Problems

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    March 10, 2023 — Eric Washington, former linebacker for the University of Kansas’ football team, got involved with sports as a child. “We crashed into each other when we played, and whoever was strongest or most reckless was thought to have the best sports career ahead of them,” he says.

    He and his friends boxed and played football on each other’s lawns “with no equipment or protection, just a lot of guys engaging in high collision together.”

    In high school, Washington became a successful football player. “You had to show people you weren’t scared, so you took on bigger … guys and ran into them,” he recalls. “I became one of those fearless people who was known as ‘that guy’ — a hard-hitter, relentless, reckless person.”

    Washington’s first major brain injury took place in ninth grade. “It was the first head-on-head collision that knocked me out and I missed much of ninth grade because of it,” he says. “I went from being a quiet, reserved, mild-mannered person to being aggressive, having mood swings, and lashing out.”

    He developed problems with memory and concentration, which worsened as he got into college football. “I remember two or three times when I got dazed after a head injury and they took me out, but then I got right back in the game,” he says. 

    Like Washington, many athletes experience brain injuries during their careers, with between 1.6 and 3 million sports- and recreation-related concussions taking place annually, around 300,000 of which are from football. 

    Cognitive changes following concussions are also common. A new study published in the Archives of Clinical Neuropsychology shines light on the problem.

    For Washington, the concussions, and their effects, continued into college. While on a football scholarship at Kansas, “I thought everything was OK. Even after my concussions, I could still get back in the game and my body retained ‘muscle memory’ of how to play football and could follow directions, even if my mind wasn’t quite there anymore.”

    During senior year, a neck and spinal cord injury ended his sports career. “Everything spiraled downward after that,” he says. “I ended up in terrible relationships, distant from my family, and even homeless for a while. I ended up in mental institutions and in dark places and with cognitive problems.”

    Does Concussion Affect Long-Term Cognitive Functioning?

    In the new study, investigators examined 353 former NFL players (average age, 54 years old) who had been retired from their playing careers for close to 3 decades. 

    Using a laptop or tablet, the former players completed a battery of neuropsychological tests through an online platform called TestMyBrain. An array of cognitive functions were tested, including processing speed, visual-spatial and working memory, short- and long-term memory, and vocabulary.

    The players completed a 76-item questionnaire that included 10 questions about signs and symptoms of concussion following a blow to the head while playing football: headaches, nausea, dizziness, loss of consciousness, memory problems, disorientation, confusion, seizure, visual problems, or feeling unsteady on their feet. They were also asked if they had ever been diagnosed with a concussion.

    Senior study author Laura Germine, PhD, director of the Laboratory for Brain and Cognitive Health Technology at McLean Hospital in Boston, says we know the impact of concussions on short-term health, but “it’s not as clear how concussion history impacts cognitive functioning in the longer term among former professional football players.” 

    She says there “have been lots of mixed findings in former players, so we wanted to address this question using sensitive, state-of-the-art and objective measures of cognitive function in a larger samples of former players than has previously been tested for this kind of study.” 

    One reason for the “mixed findings” in earlier research is that some studies have focused on diagnosed concussions and cognitive problems. But many football players’ concussions don’t end up being diagnosed, so the researchers decided to look specifically at concussion symptoms.

    Accelerated Cognitive Aging 

    Former players who reported more concussion symptoms scored worse on cognitive tests. For example, the differences in visual memory between the players with the highest- and lowest- reported concussion symptoms were equal to differences in cognitive performance between a typical 35-year-old and a typical 60-year-old.

    On the other hand, poorer cognitive performance wasn’t connected to the number of diagnosed concussions, the number of years they played professional football, or the age when the first played football. 

    The researchers conducted a follow-up study comparing the 353 players to 5,086 men who didn’t play football. They found that cognitive performance was generally worse in the former players

     “While our findings aren’t conclusive in this respect, we did see the biggest differences in cognitive performance (compared with men of similar age) among older players,” Germine says.

    Long-Term Cognitive Issues

    Washington continues to struggle with cognitive problems.

    “My long-term memory seems like it’s intact sometimes, but after a period of time, there are ‘holes.’ Or I look at people and I might recognize a face, but I don’t remember who the people are.”

    He also has difficulties with reading and memory. “My eyes have issues with tracking and tracing. And if I read out loud, I’ll be stuttering and sputtering and won’t be able to retain what I’ve just read. Sometimes, I’ll put the remote in the freezer, or I’ll set my phone down outside and won’t know where it is.”

    Washington did complete college, graduating with a bachelor’s degree in applied behavioral science that led him to work with adults with developmental disabilities. However, schoolwork was difficult and has become even more difficult of late.

    “I’d like to become a social worker to help other people, but trying to get through my classes may not be in the cards,” he says.

    He’s currently being treated for cancer and the chemotherapy also affects his cognition. “I was getting A’s in my classwork in one course, but I couldn’t remember anything on the final, so I got an F and failed the course,” he says.

    He hopes that as the cancer resolves, he’ll be able to give his studies another try. Although the cognitive challenges resulting from his concussions remain formidable, “not having ‘chemo-brain’ will free up some cognitive abilities and hopefully I’ll do better in my classes and get my social work degree.”

    Get Appropriate Support

    Germine says the study findings “underscore the need for parents, school systems, and anyone who plays football to understand the importance of reporting any and all concussion symptoms, even if they don’t feel serious at the time.” 

    She notes that “appropriate measures to address and reduce the impact of head injury — even in the absence of diagnosed concussions — may be key to maintaining cognitive health long-term.”

    Additionally, “we need to be doing everything we can to prevent head injury and concussion from happening in the first place. Measures that reduce the likelihood of head impact are important to make football safer for developing brains,” she says.

    Washington urges people to take head injuries seriously and not just “return to the game” and to be evaluated for a concussion; and if a concussion is diagnosed, to receive treatment for the symptoms (such as emotional trauma, attentional or memory problems, or visual problems).

    In addition, both encourage people who have sustained a concussion to get emotional support. Washington attends support groups offered by the Brain Injury Association of America.

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  • Bruce Willis’ Wife Slams Trolls Accusing Her Of Using His Dementia For Personal Gain

    Bruce Willis’ Wife Slams Trolls Accusing Her Of Using His Dementia For Personal Gain

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    Emma Heming Willis, a fierce defender of husband Bruce Willis, showed she’s just as protective of herself Wednesday, warning trolls claiming she’s using his dementia diagnosis to promote herself that she “didn’t come to play.”

    “I just saw something about me getting my ‘five minutes,’ which is great, which means that you’re listening,” she said in an Instagram video addressing critics. “So, I’m going to take my five minutes and I’m gonna turn it into 10 because I’m always going to advocate for my husband.”

    Willis, a professional model, married the “Die Hard” star in 2009. Since revealing her husband’s diagnosis of frontotemporal dementia, or FTD, in February, she said, some people have decried her as a fame-seeker.

    “While I’m at it, I’m going to raise awareness around FTD and for caregivers who are our unsung heroes out there,” she continued in her video. “And then, I am gonna turn my grief and my anger and my sadness and do something good around something that feels less than.”

    “So watch this space,” she added, “because I didn’t come to play.”

    A few days earlier, Willis asked paparazzi to keep their distance and stop badgering her husband with questions.

    The actor’s family announced his retirement in 2022 after an aphasia diagnosis, then confirmed its progression to FTD last month.

    “Unfortunately, challenges with communication are just one symptom of the disease Bruce faces,” the family said in a statement at the time. “While this is painful, it is a relief to finally have a clear diagnosis. FTD is a cruel disease that many of us have never heard of and can strike anyone.”

    The family statement added that Willis would raise awareness about FTD himself if he could. His wife has taken on that effort instead.

    “I put my family’s needs above my own, which I found does not make me any kind of hero,” Emma Heming Willis told The Bump in an interview published in May 2022. “We just love spending time with each other and we know that time is precious, and I don’t take that for granted.”

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  • Terry Holland, who transformed Virginia basketball, dies

    Terry Holland, who transformed Virginia basketball, dies

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    Terry Holland, who elevated Virginia basketball to national prominence during 16 seasons as coach and later had a distinguished career as an athletic administrator, has died, the school announced Monday. He was 80.

    Holland died Sunday night, according to the school, which confirmed the death with his family. His health had declined since he was diagnosed with Alzheimer’s disease in 2019 and he stopped taking his prominent courtside seat at Virginia home games.

    Holland took over a flailing program in 1974. The Cavaliers had had just three winning seasons in 21 years and Holland created a culture that proved a formula for success: His Cavaliers played rugged defense.

    Two of his first three teams finished with losing records but only one more did as Holland compiled a 326-173 record, led Virginia to nine NCAA Tournaments, two Final Fours and the 1980 NIT title. He also guided the Cavaliers to their first Atlantic Coast Conference Tournament title in 1976 despite a modest 15-11 regular-season record.

    Including a five-year stint at Davidson, Holland’s record is 418-216.

    His biggest victory, however, likely was luring the nation’s most coveted recruit, 7-foot-4 Ralph Sampson of Harrisonburg, to join the Cavaliers for the 1979-80 season, and it was then that the turnaround took off.

    “Terry Holland,” Sampson told The Associated Press in an interview earlier this month when asked what made him choose upstart Virginia over more established suitors. “He was mainly the deciding factor. Good school, good teammates, good education, ACC. I mean, you had Dean Smith and all those people around, but he understood my demeanor and fit what I wanted in a coach. He was the perfect fit for me.”

    The Cavaliers won the NIT in Sampson’s freshman season and went to the NCAA Tournament for his last three years, reaching the Final Four in 1981 before losing to North Carolina in the national semifinals.

    Sampson, a future Hall of Famer, earned national player of the year honors in each of his last three seasons, and the profile his presence provided surely aided Holland in building his program. Virginia went back to the Final Four in its first season without Sampson, losing in overtime to Houston in the national semifinals, and appeared in the NCAA Tournament in four of Holland’s final six seasons as coach.

    Holland also built an extensive coaching tree, with many assistants moving on to become successful head coaches themselves. Among them: Rick Carlisle of the Indiana Pacers, Jim Larrañaga at Miami, Jeff Jones at Old Dominion and former longtime college coaches Dave Odom and Seth Greenberg.

    With two daughters of his own, Holland also had an appreciation for the women’s game, former Cavaliers coach Debbie Ryan said.

    “He knew that we had to go to Clemson and Georgia Tech, so he helped us to get the league to schedule both of us on the same days to play doubleheaders,” she said. “We would fly down to Clemson, bus to Georgia Tech and then fly back, the men’s and the women’s team together, so that it would save us all that wear and tear.”

    He also was always concerned about during the right thing, she said.

    “He wasn’t impressed with himself at all,” she said, describing him as a Southern gentleman. “He was just there to make sure these boys became men and they became good men.”

    When he stepped down as coach at age 48, it was to return to his alma mater, Davidson, as athletic director, beginning an administrative tenure that would bring him back to Virginia five years later in the same position. In 2001, he moved to special assistant to the president of the university, and in 2004, he began an eight-year stint as athletic director at East Carolina before retiring in 2012.

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    More AP college basketball: http://apnews.com/Collegebasketball and https://twitter.com/AP_Top25

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  • Animals’ medical superpowers

    Animals’ medical superpowers

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    Animals’ medical superpowers – CBS News


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    There are examples from across the animal kingdom of medical marvels – animals whose behaviors and diet may point to ways in which humans might reduce heart disease, or ward off dementia. Correspondent Jonathan Vigliotti talks with Dr. David Agus, author of “The Book of Animal Secrets,” and Dr. Joshua Schiffman, who is exploring how an elephant’s genetics may offer clues to fighting off cancerous cells.

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  • Actor Bruce Willis’ family says he has been diagnosed with frontotemporal dementia

    Actor Bruce Willis’ family says he has been diagnosed with frontotemporal dementia

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    Actor Bruce Willis’ family says he has been diagnosed with frontotemporal dementia – CBS News


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    Bruce Willis’ family says the actor has been diagnosed with frontotemporal dementia, which can affect a person’s personality, behavior, language and movement. There are no approved treatments, and there is no cure. Carter Evans reports and Dr. David Agus has more on what the diagnosis means.

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  • Scout Willis Says She’s ‘In Awe’ Of Loving Response To Bruce Willis’ New Diagnosis

    Scout Willis Says She’s ‘In Awe’ Of Loving Response To Bruce Willis’ New Diagnosis

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    Scout Willis said she was “a bit overwhelmed” by reaction to her father Bruce Willis’ new medical diagnosis of frontotemporal dementia, or FTD.

    “Feeling emotionally tired and a bit overwhelmed, yet also very in awe of the love so many people have for my papa,” Scout said in a photo posted on her Instagram story Thursday after her family released a statement announcing the “Die Hard” actor’s diagnosis.

    The actor’s wife, Emma Heming Willis, ex-wife Demi Moore and Willis’ daughters Rumer, Scout, Tallulah, Mabel and Evelyn, later spoke about the condition.

    “FTD is a cruel disease that many of us have never heard of and can strike anyone,” the family said in a statement posted on the Association for Frontotemporal Degeneration website. “For people under 60, FTD is the most common form of dementia, and because getting the diagnosis can take years, FTD is likely much more prevalent than we know.”

    Rumer Willis, Demi Moore, Bruce Willis, Scout Willis, Emma Heming Willis and Tallulah Willis attend Demi Moore’s ‘Inside Out’ Book Party on Sep. 23, 2019, in Los Angeles.

    Stefanie Keenan via Getty Images

    “Unfortunately, challenges with communication are just one symptom of the disease Bruce faces,” the family statement continued. “While this is painful, it is a relief to finally have a clear diagnosis.”

    Willis’ family announced last year that “The Sixth Sense” actor had been diagnosed with aphasia, a condition that typically occurs after a head injury or stroke, and said he would be retiring from acting.

    The family explained that they publicly revealed the dementia diagnosis because the actor “always believed in using his voice in the world to help others, and to raise awareness about important issues both publicly and privately.”

    “We know in our hearts that — if he could today ― he would want to respond by bringing global attention and a connectedness with those who are also dealing with this debilitating disease and how it impacts so many individuals and their families,” the family said.

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  • Bruce Willis has frontotemporal dementia. What is FTD?

    Bruce Willis has frontotemporal dementia. What is FTD?

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    Bruce Willis’ family has announced that he has been diagnosed with frontotemporal dementia.

    The announcement Thursday came about a year after his family said that Willis would step away from acting after being diagnosed with aphasia, a brain disorder that leads to speaking, reading and writing problems.

    Here’s some details on the condition:

    WHAT IS FRONTOTEMPORAL DEMENTIA?

    There are different types of dementia, and the frontotemporal form affects regions in the front and sides of the brain. Because it causes problems with behavior and language, aphasia can be a symptom.

    It’s caused by damage to neurons, the brain’s information carriers, but the underlying reasons for a particular case are often unclear. People with a family history of the condition are more likely to develop it. It’s rare and tends to happen at a younger age than other forms of dementia, between ages 45 and 65.

    The terms frontotemporal disorders and frontotemporal dementia are sometimes shortened to FTD.

    WHAT ARE OTHER SYMPTOMS OF FTD?

    Symptoms can include emotional problems and physical difficulties, such as trouble walking. Symptoms tend to worsen over time, though progression varies by person.

    The statement from the actor’s family said communication problems “are just one symptom of the disease Bruce faces.”

    CAN FTD BE TREATED?

    There are no treatments to slow or stop the disease, but some interventions can help manage symptoms.

    Some patients receive antidepressants or drugs for Parkinson’s, which has some overlapping symptoms with frontotemporal dementia. Many also work with speech therapists to manage communication difficulties and physical therapists to try to improve movement.

    People with the condition are more likely to have complications from things like falls, injuries or infections. The average life expectancy after symptoms emerge is seven to 13 years, according to researchers.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Bruce Willis has frontotemporal dementia, condition worsens

    Bruce Willis has frontotemporal dementia, condition worsens

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    NEW YORK (AP) — Nearly a year after Bruce Willis’ family announced that he would step away from acting after being diagnosed with aphasia, his family says his “condition has progressed.”

    In a statement posted Thursday, the 67-year-old actor’s family said Willis has a more specific diagnosis of frontotemporal dementia.

    “While this is painful, it is a relief to finally have a clear diagnosis,” the statement read. “FTD is a cruel disease that many of us have never heard of and can strike anyone.”

    Last March, Willis’ family said his aphasia had affected his cognitive abilities. The condition causes loss of the ability to understand or express speech.

    In Thursday’s statement, his family said communication challenges were just one symptom of frontotemporal dementia.

    The Association for Frontotemporal Degeneration describes FTD as a group of brain disorders caused by degeneration of the frontal and/or temporal lobes of the brain that affects behavior, language and movement. Aphasia can be a symptom of it. The association describes frontotemporal degeneration as “an inevitable decline in functioning,” with an average life expectancy of seven to 13 years after the onset of symptoms.

    “Today there are no treatments for the disease, a reality that we hope can change in the years ahead,” the family’s statement read, adding that it can take years to get a proper diagnosis. “As Bruce’s condition advances, we hope that any media attention can be focused on shining a light on this disease that needs far more awareness and research.”

    The statement was posted on the website for the Association for Frontotemporal Degeneration and signed by Willis’ wife, Emma Heming Willis, his ex-wife Demi Moore, and his five children, Rumer, Scout, Tallulah, Mabel and Evelyn.

    Over a four-decade career, Willis’ movies had earned more than $5 billion at the worldwide box office. While beloved for hits like “Die Hard” and “The Sixth Sense,” the prolific actor had in recent years primarily featured in direct-to-video thrillers.

    “Bruce has always found joy in life — and has helped everyone he knows to do the same,” the family said Thursday. “It has meant the world to see that sense of care echoed back to him and to all of us. We have been so moved by the love you have all shared for our dear husband, father, and friend during this difficult time. Your continued compassion, understanding, and respect will enable us to help Bruce live as full a life as possible.”

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  • Bruce Willis diagnosed with dementia

    Bruce Willis diagnosed with dementia

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    Bruce Willis diagnosed with dementia – CBS News


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    Bruce Willis’ family announced he has dementia. Last year, Willis was diagnosed with aphasia, which affects speech. His family said that has progressed into frontotemporal dementia.

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  • Bruce Willis has frontotemporal dementia, condition worsens

    Bruce Willis has frontotemporal dementia, condition worsens

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    NEW YORK — Nearly a year after Bruce Willis’ family announced that he would step away from acting after being diagnosed with aphasia, his family says his “condition has progressed.”

    In a statement posted Thursday, the 67-year-old actor’s family said Willis has a more specific diagnosis of frontotemporal dementia.

    “While this is painful, it is a relief to finally have a clear diagnosis,” the statement read. “FTD is a cruel disease that many of us have never heard of and can strike anyone.”

    Last March, Willis’ family said his aphasia had affected his cognitive abilities. The condition causes loss of the ability to understand or express speech.

    In Thursday’s statement, his family said communication challenges were just one symptom of frontotemporal dementia.

    “Today there are no treatments for the disease, a reality that we hope can change in the years ahead,” the statement read. “As Bruce’s condition advances, we hope that any media attention can be focused on shining a light on this disease that needs far more awareness and research.”

    The statement was posted on the website for The Association for Frontotemporal Degeneration and signed by Willis’ wife, Emma Heming Willis, his ex-wife Demi Moore, and his five children, Rumer, Scout, Tallulah, Mabel and Evelyn.

    Over a four-decade career, Willis’ movies had earned more than $5 billion at the worldwide box office. While beloved for hits like “Die Hard” and “The Sixth Sense,” the prolific actor had in recent years primarily featured in direct-to-video thrillers.

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  • A Healthy Lifestyle Might Delay Memory Decline in Older Adults

    A Healthy Lifestyle Might Delay Memory Decline in Older Adults

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    Feb. 2, 2023 — A new study suggests that following a healthy lifestyle is linked to slower memory decline in older adults, even in people with the apolipoprotein E4 (APOE4) gene, one of the strongest known risk factors for Alzheimer’s disease and related dementias.

    A team of investigators in China analyzed 10-year data on over 29,000 older adults with an average age of 72 years. Of these, a fifth were carriers of the APOE4 gene.

    The investigators created a healthy lifestyle score by combining how much participants engaged in six activities: healthy diet, regular exercise, active social contact, cognitive activity, nonsmoking, and avoiding alcohol. Participants were grouped into having “favorable,” “average,” and “unfavorable” lifestyles.

    After adjusting for health, economic, and social factors, the researchers found that each individual healthy behavior was associated with a slower-than-average decline in memory during the decade, with a healthy diet emerging as the strongest deterrent, followed by cognitive activity and then physical exercise.

    Those with “favorable” or “average” lifestyle showed slower memory decline, regardless of whether or not they had the APOE4 gene.

    “A healthy lifestyle is associated with slower memory decline, even in the presence of the APOE4 allele,” wrote Jianping Jia, MD, PhD, of the Innovation Center for Neurological Disorders and Department of Neurology, Xuan Wu Hospital, Capital Medical University in Beijing, China, and co-authors.

    “This study might offer important information to protect older adults against memory decline,” they wrote. 

    The study was published online Jan. 25 in the BMJ.

    Senior Moments?

    Memory “continuously declines as people age,” but age-related memory decline doesn’t necessarily mean the person is developing dementia, according to the authors. 

    Factors affecting memory include aging, APOE4 genotype, chronic diseases, and lifestyle patterns. In particular, the role of lifestyle has been “receiving increasing attention” because, unlike a person’s genes or certain health conditions, lifestyle can be changed. 

    The researchers wanted to understand the role of a healthy lifestyle in possibly slowing memory decline, including in people with the APOE4 genotype. So they drew on data from the China Cognition and Ageing Study, which began in 2009 and ended in 2019. 

    At baseline, those in the study who were considered “cognitively normal”  completed tests of cognition and memory and also provided information about their lifestyle, health, and economic and social factors. They were then reassessed in 2012, 2014, 2016, and at the conclusion of the study. The long follow-up period allowed for evaluation of individual lifestyle factors on memory function over time.

    “Lifestyle” consisted of six factors:

    • Physical exercise (weekly frequency and total time)
    • Smoking status (current smoker, former smoker, or never smoked)
    • Alcohol use (never drank, drank occasionally, low-to-excess drinking, and heavy drinking)
    • Diet (daily intake of 12 food items: fruits, vegetables, fish, meat, dairy products, salt, oil, eggs, cereals, legumes, nuts, tea)
    • Cognitive activity (writing, reading, playing cards, mahjong, other games)
    • Social contact (participating in meetings, attending parties, visiting friends/relatives, traveling, chatting online)

    The people’s lifestyle was scored based on the number of healthy factors they engaged in, with “favorable” lifestyle consisting of four to six healthy factors, “average” lifestyle consisting of two to three healthy factors, and “unfavorable” lifestyle consisting of one to two healthy factors.

    Public Health Implications

    During the 10-year period, 7,164 people in the study died while 3,567 discontinued participation.

    Compared with the group that had unfavorable lifestyles, memory decline in the favorable lifestyle group was 0.28 points slower over the decade-long study, and memory decline in the average group was 0.16 points lower.

    Those with favorable or average lifestyle were almost 90% and 30% respectively less likely to develop dementia or mild cognitive impairment, compared to those with an unfavorable lifestyle.

    The authors noted some limitations in their findings. For one, the study was observational, meaning that we don’t know whether the healthy lifestyle actually caused slower memory decline, or whether the association might be due to something else. 

    Still, the findings “might offer important information for public health to protect older adults against memory decline,” especially since the study “provides evidence that these effects also include individuals with the APOE4 allele,” the study authors said. 

    ‘Important and Encouraging’ Findings

    Severine Sabia, PhD, a senior researcher at the Université Paris Cité, INSERM Institut National de la Santé et de la Recherche Medicalé in France, called the findings “important and encouraging.”

    That said, Sabia, who is also the co-author of an accompanying editorial, notes that “there remain important research questions that need to be investigated in order to identify key behaviors, which combination [of behaviors], the cut-off of risk, and when to intervene.”

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  • Marriage Could Be a ‘Buffer’ Against Dementia

    Marriage Could Be a ‘Buffer’ Against Dementia

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    By Amy Norton 

    HealthDay Reporter

    TUESDAY, Jan. 31, 2023 (HealthDay News) — Tying the knot is now tied to healthier aging brains: People who stay married for the long haul may gain some protection from dementia, a new study suggests.

    Researchers found that compared with both divorced people and lifelong singles, older adults in a long-term marriage were less likely to develop dementia. Roughly 11% were diagnosed with dementia after age 70, versus 12% to 14% of their divorced or single counterparts.

    When the researchers weighed other factors that could affect dementia risk — like education levels and lifestyle habits — long-term marriage was still linked to a protective effect: Divorced and unmarried adults were 50% to 73% more likely to be diagnosed with dementia.

    The study is not the first to tie marital status to dementia risk, according to researcher Bjorn Heine Strand, a senior scientist with the Norwegian Institute of Public Health, in Oslo.

    “Marriage has been reported to be associated with reduced dementia risk in numerous studies, and our results add to this evidence,” Strand said.

    The big question is why the link exists. Figuring out the reasons, Strand said, is important — especially considering changing demographics and social norms. The elderly population is growing, meaning more people are at risk of dementia; meanwhile, more people are getting divorced or saying no to marriage altogether.

    The findings, published in the Journal of Aging and Health, are based on over 8,700 Norwegian adults whose marital status was tracked from age 44 to 68. Strand’s team then looked for correlations with participants’ likelihood of being diagnosed with dementia after age 70.

    Overall, just under 12% were diagnosed with dementia during the study period, while another 35% developed mild cognitive impairment — problems with memory and thinking skills that may, or may not, progress to dementia.

    In general, Strand’s team found, marital status was not strongly tied to the risk of milder impairments. But there was a clear relationship with dementia risk: Staying married conferred more protection, versus being divorced (consistently or “intermittently”) or unmarried (which counted singles and people who lived with a partner).

    The researchers tried to find explanations. Physical health conditions, like heart disease, may contribute to dementia. Similarly, depression, lower education levels, smoking and being sedentary have all been tied to higher dementia risk.

    None of those factors, however, seemed to fully account for why divorced and unmarried people had a higher dementia risk.

    When the researchers focused on the unmarried group, it did appear that being childless accounted for a good deal of the relationship with higher dementia risk. But that still leaves the question of why.

    “Some of the explanation could be that if you have children, you stay more cognitively engaged,” Strand said. “For example, you have to deal with people and participate in activities that you wouldn’t otherwise have to.”

    It’s theorized, he noted, that such mental and social stimulation — as well as formal education — may help thwart dementia to a degree. People who are more cognitively engaged throughout life may have more “cognitive reserve” — an ability to withstand more of the brain changes that mark the dementia process before symptoms appear.

    The findings are consistent with past research on marital status and dementia, agreed Claire Sexton, senior director of scientific programs and outreach for the Alzheimer’s Association.

    But there are “important caveats,” said Sexton, who was not involved in the study.

    One is that studies like this cannot prove cause and effect. Beyond that, Sexton said, it’s not clear whether findings from older generations would apply to young people today. It’s now much more common, for example, for unmarried couples to live together, versus decades ago.

    And then there’s the bigger picture. Dementia is complicated, Sexton said, and influenced by many factors — including age, genetics, lifestyle habits, physical health and environment. If marital status matters, it would be only one of the variables.

    For now, Sexton pointed to the importance of staying socially connected, which may be part of the story when it comes to marital status and dementia.

    “Staying socially engaged may support cognitive health,” she said. “The Alzheimer’s Association recommends engaging in social activities that are meaningful to you, and that you share those activities with friends and family.”

    In this study, Strand’s team did look at whether people reported having “no close friends,” and that did not explain their findings.

    But in future work, he said, they plan to dig deeper — looking at whether social inactivity, loneliness or general life satisfaction could help explain why marital status is tied to dementia risk.

    More information

    The Alzheimer’s Association has advice on supporting brain health.

     

    SOURCES: Bjorn Heine Strand, PhD, senior scientist, department of physical health and aging, Norwegian Institute of Public Health, Oslo, Norway; Claire Sexton, DPhil, senior director, scientific programs & outreach, Alzheimer’s Association, Chicago; Journal of Aging and Health, Nov. 2, 2022, online

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  • Federal regulator won’t ban gas stoves after all

    Federal regulator won’t ban gas stoves after all

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    A federal regulator has walked back comments about banning gas stoves after backlash to the idea of a ban reached a fever pitch this week. 

    Consumer Product Safety Commissioner Richard Trumka, Jr., told Bloomberg in an interview this week that a ban was “on the table” for gas stoves, which research has linked to health problems including asthma.

    “Products that can’t be made safe can be banned,” Trumka told the media outlet. Trumka also highlighted the health dangers of gas stoves in an appearance last month before the Public Interest Research Group.

    “We need to be talking about regulating gas stoves, whether it’s drastically reducing emissions or banning gas stoves entirely,” Trumka told PIRG, adding that a ban “is a powerful tool in our toolbox and it’s a real possibility here, particularly because there seem to be readily available alternatives already in the market.”

    The prospect of a ban inflamed the gas industry and plenty of politicians, who painted the problem as an issue of government overreach.

    Rep. Byron Donald (R-Fla.) tweeted at President Biden to “get your hands off our gas stoves!!!!”

    “If you know ANYTHING about cooking, there is nothing like cooking on a gas stove,” he said.

    By Tuesday afternoon, the chair of the CPSC clarified that, while the commission is looking at ways to make stoves safer, there would be no ban in the immediate future. 

    “I am not looking to ban gas stoves and the CPSC has no proceeding to do so,” he said. “CPSC is resarching gas emissions in stoves and exploring ways to address health risks.”

    Trumka also clarified that any ban would apply to new products — not gas stoves Americans currently own.

    What will happen, according to Trumka and CPSC records, is a crowdsourced effort to make stoves safer. The CPSC will issue a request for information this spring asking consumers, industry groups and other parties for ideas to mitigate the effects of gas stoves, Trumka said in December.

    Dementia and asthma risks

    Research is mounting that gas stoves — used by one-third of Americans for cooking — are bad for people’s health. A December study found that 13% of childhood asthma cases nationwide can be blamed on indoor use of gas stoves. A previous study from a decade ago found that a gas stove at home increased a child’s risk of asthma by 42%. 

    Cooking on these stoves emits nitrous oxide and fine particulates, which can build up in minutes to levels deemed unsafe by the Environmental Protection Agency. Fine particulates have also been linked with higher rates of dementia and Alzheimer’s disease, according to a research article this month from the Proceedings of the National Academy of Sciences

    Even when gas stoves are off, meanwhile, they emit large amounts of methane, a potent greenhouse gas that is dozens of times more damaging for the climate than carbon dioxide.


    MoneyWatch: Study reveals climate and health impact from gas stoves

    05:29

    Citing the appliances’ harmful environmental impact, dozens of U.S. cities have banned gas stoves in new buildings, while about 20 states have banned them on the local level.

    The American Gas Association has pushed back against research demonstrating gas stoves’ dangers. It previously said that emissions from cooking with gas are similar to emissions created when cooking with electric stoves and that it planned to submit evidence to that effect.

    On Tuesday, it slammed the latest study to link gas stoves to asthma, calling it findings “baseless allegations” and pointing to the role of gas in reducing carbon emissions from the power sector by pushing out more-polluting coal.

    “Any efforts to ban highly efficient natural gas stoves should raise alarm bells for the 187 million Americans who depend on this essential fuel every day,” the AGA said in a statement

    Limitations on gas stoves are a major concern for the industry, which in 2020 was found to be paying influencers to tout the benefits of cooking with gas.

    But public health advocates say that stoves are a glaring exception in health laws that require gas-burning appliances to be vented outdoors. They say the latest research should impel cities and states to accelerate the transition to clean energy and get off fossil fuels entirely.

    Gas is “killing us in our own homes,” Raya Salter, executive director of the Energy Justice Law and Policy Center, told City Limits recently.

    Pushing for rules

    Any attempt to regulate stoves, even to improve public health, will likely meet intense pushback from industry and consumers who are attached to their gas stoves. And while some experts say there are superior cooking appliances, such as induction stoves, they cost more upfront than gas stoves, and many Americans conflate this technology with older electric-coil cooktops. 

    All the more reason to shine a light on the health and environmental concerns around gas stoves, CPSC’s Trumka said last month.

    “The vast majority of Americans have no idea that every time they cook they could be subjecting themselves and their loved ones to toxic chemicals, including children who are more vulnerable to effects like developing asthma and lifelong respiratory disease,” he told PIRG.  

    Trumka sounded a hopeful note, saying that a proposed regulation could be on the books as early as December 2023.

    “Just because the federal government isn’t known for moving quickly doesn’t mean it couldn’t,” he added.

    This story has been updated.

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  • This Company Is Turning the “DNA” of Music Into Medicine – EDM.com

    This Company Is Turning the “DNA” of Music Into Medicine – EDM.com

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    There’s good reason to believe the emerging field of music therapy is a multi-billion dollar industry in-waiting.

    As the team at MediMusic notes, music has consistently shown promise in its naturally healing potential. Prior studies on music exposure has shown the art form demonstrates the benefit of reducing anxiety by up to 44%, and pain reduction by 29%. 

    Knowing those statistics, there’s certainly good reason to believe music is medicine. But in this case, it’s more than a cliché. MediMusic is prescribing music to help remediate a variety of everyday and chronic ailments.

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    Cameron Sunkel

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  • BioVie Shares jump Premarket on Parkinson’s, Alzheimer’s Studies >BIVI

    BioVie Shares jump Premarket on Parkinson’s, Alzheimer’s Studies >BIVI

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    By Colin Kellaher

    Shares of BioVie Inc. rose sharply in premarket trading Tuesday after the clinical-stage biopharmaceutical company reported positive results from a pair of Phase 2 studies assessing the potential of its NE3107 drug candidate in Parkinson’s disease and Alzheimer’s disease.

    The Carson City, Nev., company said the study of NE3107 in Parkinson’s met both main objectives, with patients treated with a combination of the drug and levodopa seeing meaningful improvements in their motor score and an absence of adverse interactions of NE3107 with levodopa.

    BioVie said that based on the study findings, it will proceed with planning the Phase 3 program for discussion with the U.S. Food and Drug Administration.

    Meanwhile, BioVie said patients treated with NE3107 in the Alzheimer’s study experienced improved cognition and biomarker levels, with no drug-related adverse events observed.

    BioVie shares, which closed Monday at $5.21, were recently up 15% to $5.98 in premarket trading.

    Write to Colin Kellaher at colin.kellaher@wsj.com

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  • Is It Long COVID, or Dementia, or Both?

    Is It Long COVID, or Dementia, or Both?

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    Nov. 28, 2022 In early September, about a week after recovering from COVID-19, Barri Sanders went to the bank to pay a bill. But by mistake, she transferred a large amount of money from the wrong account. 

    “I’m talking about $20,000,” she says. “I had to go back [later] and fix it.”

    Sanders, 83, had not had confusion like that before. Suddenly, the Albuquerque, NM, resident found herself looking up from a book and not remembering what she had just read. She would stand up from her chair and forget what she meant to do. 

    “I kind of thought it was just the aging process,” she says. Combined with sudden balance issues, insomnia, and a nagging postnasal drip, the overall effect was “subtle, but scary,” she says.

    After 5 days of this, she went to bed and slept the whole night through. She woke up in the morning to find her balanced restored, her sinuses clear, and the mental fog gone. What she’d had, she realized, wasn’t a rapid start of dementia, but rather a mercifully short form of long COVID.

    Somewhere between 22% and 32% of people who recover from COVID-19 get “brain fog,” a non-scientific term used to describe slow or sluggish thinking. While this is disturbing at any age, it can be particularly upsetting to older patients and their caregivers, who fear they’re having or witnessing not just an after-effect of a disease, but the start of a permanent loss of thinking skills. And some scientists are starting to confirm what doctors, patients, and their families can already see: Older patients who have had COVID-19 have a higher risk of getting dementia or, if they already have mental confusion, the illness may worsen their condition. 

    British scientists who studied medical records from around the world reported in the journal The Lancet Psychiatry in August that people who recovered from COVID-19 had a higher risk of problems with their thinking and dementia even after 2 years had passed. 

    Another 2022 study, published in the journal JAMA Neurology, looked at older COVID-19 patients for a year after they were discharged from hospitals in Wuhan, China. Compared with uninfected people, those who survived a severe case of COVID-19 were at higher risk for early onset, late-onset, and progressive decline in their thinking skills. Those who survived a mild infection were at a higher risk for early onset decline, the study found. 

    Eran Metzger, MD, an assistant professor of psychiatry at Beth Israel Deaconess Medical Center in Boston, says he’s noticed that COVID-19 makes some older patients confused, and their brains don’t regain their former clarity. 

    “We see a stepwise decline in their cognition during the COVID episode, and then they never get back up to their baseline,” says Metzger, medical director at Hebrew SeniorLife. 

    New research is beginning to back up such findings. 

    People who got COVID-19 were twice as likely to receive a diagnosis of Alzheimer’s disease in the 12 months after infection, compared to those who didn’t get COVID, according to a study published in the journal Nature in September, which analyzed the health care databases of the U.S. Department of Veterans Affairs.

    Joshua Cahan, MD, a cognitive neurologist at Northwestern University, advises caution about applying such a specific label simply from a patient’s medical chart. After all, he notes, few patients get tested to confirm that they have the proteins linked to Alzheimer’s. 

    “Probably the most appropriate conclusion from that is that there’s an increased risk of dementia after a COVID infection,” he says, “but we don’t know whether it’s truly Alzheimer’s disease or not.”

    There could be a number of reasons why COVID-19 triggers a decline in thinking skills, says Michelle Monje, MD, a neuroscientist and neuro-oncologist at Stanford University.

    In a paper published in October in the journal Cell, Monje and her co-author, Akiko Iwasaki, PhD, a professor of immunobiology at Yale University, propose six possible triggers for brain fog caused by COVID: inflammation in the lungs and respiratory passages that leads to inflammation and dysregulation of the central nervous system; autoimmune reactions that damage the central nervous system; brain infection directly caused by the coronavirus (though, they note, this appears rare); a re-activation of a Epstein-Barr virus, which can lead to neuro-inflammation; triggered by the coronavirus; and/or complications from severe cases of COVID-19, possibly involving periods of low blood oxygen and multi-organ failure. 

    Scientific understanding of brain fog is “part of an emerging picture that inflammation elsewhere in the body can be transmitted to become inflammation in the brain,” Monje says. “And once there’s inflammation in the brain … that can dysregulate other cell types that normally support healthy cognitive function.”

    One issue with the concept of brain fog is that, like the term itself, the condition can be tough to define for doctors and patients alike and hard, if not impossible, to capture on common cognition tests. 

    These days, patients often arrive at the Center of Excellence for Alzheimer’s Disease, in Syracuse, NY, complaining that they “don’t feel the same” as they did before contracting COVID-19, says Sharon Brangman, MD, the center’s director and the chair of the Geriatrics Department at Upstate Medical University. 

    But the evidence of diminished cognition just isn’t there. 

    “There’s nothing that we can find, objectively, that’s wrong with them,” she says. “They’re not severe enough to score low on mental status testing.”

    But specialized, directed testing can find some probable signs, says Cahan, who evaluates patient cognition in a long COVID clinic at Northwestern University. 

    He often finds that his long COVID patients score in the low normal range on cognitive testing. 

    “Patients do have a complaint that something’s changed, and we don’t have prior testing,” he says. “So it’s possible that they were maybe in the high normal range or the superior range, but you just don’t know.”

    He says he has seen very high-performing people, like lawyers, executives, PhDs, and other professionals, who have tests that might be interpreted as normal, but given their level of achievement, “you would expect [higher scores].”

    Like Sanders, many of those who do have muddled thinking after a COVID infection return to their former mental status. A study published in the journal Brain Communications last January found that people who had recovered from COVID-19, even if they had a mild illness, were significantly more likely to have memory and other cognition issues in the months after infection. But after 9 months, the former COVID patients had returned to their normal level of cognition, the team at Britain’s University of Oxford reported.

    Notably, though, the average age of the people in the study was 28.6. 

    At the Northwestern clinic, Cahan treats patients who have struggled with COVID-induced cognition issues for months or even years. A rehabilitation program involves working with patients to come up with ways to compensate for cognitive deficits – such as making lists – as well as brain exercises, Cahan says. Over time, patients may achieve a 75% to 85% improvement, he says.

    Monje hopes that one day, science will come up with ways to fully reverse the decline. 

    “I think what is likely the most common contributor to brain fog is this neuro-inflammation, causing dysfunction of other cell types,” she says. “And, at least in the laboratory, we can rescue that in mouse models of chemotherapy brain fog, which gives me hope that we can rescue that for people.”

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  • When destitute small towns mean dangerous tap water

    When destitute small towns mean dangerous tap water

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    KEYSTONE, W.Va. (AP) — Donna Dickerson’s heart would sink every time she’d wake up, turn on the faucet in her mobile home and hear the pipes gurgling.

    Sometimes it would happen on a day when her mother, who is 86 and has dementia, had a doctor’s appointment and needed to bathe. Sometimes it would be on Thanksgiving or Christmas when family had come to stay.

    “It was sickening, literally a headache and it disrupted everything,” she said. “Out of nowhere, the water would be gone, and we’d have no idea when it’d be back.”

    It is hard enough to care for someone with dementia. Caring for someone with dementia with no safe water takes the stress to another level.

    While failures of big city water systems attract the attention, it’s small communities like Keystone, West Virginia, that more often are left unprotected by destitute and unmaintained water providers. Small water providers rack up roughly twice as many health violations as big cities on average, an analysis of thousands of records over the last three years by The Associated Press shows. In that time, small water providers violated the Safe Drinking Water Act’s health standards nearly 9,000 times. They were also frequently the very worst performers. Federal law allows authorities to force changes on water utilities, but they rarely do, even for the worst offenders.

    “We’re talking about things that we’ve known in drinking water for a century, that we have an expectation in this country that everybody should be afforded,” said Chad Seidel, president of a water consulting company.

    The worst water providers can have such severe problems that residents are told they can’t drink the water. For 10 solid years Dickerson and 175 neighbors in the tiny, majority Black community of Keystone had to boil all their water. That length of time is nearly unheard of — such warnings usually last only for days. The requirement added gas and electricity costs on top of the water bill. In addition, residents would lose water outright for days or even weeks at a time with no warning.

    A coal company had built the original system, but since left, leaving no one in charge.

    When Dickerson’s water went out, she would drive the dying county’s winding mountain roads to the food bank, or buy water at Dollar General – one of the area’s only stores. She’d haul containers back home and heat up pots on the stove to fill the tub, so her mother could bathe. She stored water in containers in her mobile home’s two bathrooms to flush toilets. Dishes and laundry would pile up.

    There was the cost of gas, the cost of 5 gallon water jugs, the cost of washing clothes at the laundromat. There was also an emotional cost.

    “It drains you,” she said. “You have to learn how to survive.”

    When President Gerald Ford signed the landmark Safe Drinking Water Act in 1974, he said “nothing is more essential to the life of every single American,” than clean water to drink, also mentioning clean air and pure food. The law protected Americans against 22 contaminants, including arsenic. Nearly half a century later, evolving science has broadened the coverage to more than 90 substances, and strengthened standards along the way.

    The miracle is that most water systems keep up – 94% comply with health standards.

    But Dickerson lives in one of the places that didn’t, the AP found, that struggles and fails repeatedly.

    After years of problems, Keystone finally got hooked up to a new water system last December, McDowell Public Service District, which focuses on upgrading systems in coal communities. The deteriorating water mains were replaced, and a nonproft called DigDeep helped pay to connect homes to the new infrastructure.

    When a water utility doesn’t treat water properly or has high levels of a contaminant, states are supposed to enforce the law. They usually give communities time to fix problems, and often they do. But if there is intransigence or delay, the state can escalate and impose fines. In many towns, that doesn’t go well.

    “Giving them a penalty is not going to get you anywhere. It’s just going to make the situation worse in most cases,” said Heather Himmelberger, director of the Southwest Environmental Finance Center at the University of New Mexico. The towns can’t afford the work.

    Some 3% of all systems the AP analyzed landed on the EPA’s enforcement priority list last year. Even worse are the 450 utilities that stayed on the list for at least five of the last 10 years. Four million Americans rely on these systems.

    Regulators rarely step in to force change.

    “Mostly what regulators have is moral appeal and they’ll wag their finger,” said Manny Teodoro, a professor at the University of Wisconsin who focuses on public policy and water.

    The EPA says the vast majority of systems do provide safe water and for those that struggle, the agency has increased technical assistance, inspections and enforcement. Those efforts have decreased the number of systems consistently committing health violations, according to Carol King, an attorney in the EPA Office of Enforcement and Compliance Assurance.

    Teodoro said originally water systems sprouted up when communities did, giving rise to a fragmented drinking water sector dominated by small providers. School districts in America formed the same way, but went through a period of consolidation. That’s happened far less with community water systems.

    The top concern of the sector is funding for infrastructure, according to a survey.

    Josiah Cox has a special view of which towns end up in the worst trouble. He spent years working on water issues and noticed many small utility owners failed to save money for maintenance or struggled when experienced staff members left.

    So he started a business, Central States Water Resources, buying up problem utilities, doing upgrades and billing customers for the costs over time.

    Terre Du Lac, Missouri was one. It’s a private, 5,200-acre community of roughly 1,200 homes nestled around 16 lakes. It advertises a relaxed atmosphere an hour south of St. Louis where people come to golf or water ski.

    But rust coated the water tower. The community drinking water well was pulling up naturally-occurring radioactive material that can cause cancer.

    He has seen a lot: bird feces in drinking water and one place that treated its water with chlorine tablets meant for swimming pools.

    “You start what we call the death spiral of these utilities” where they don’t have the resources to pay for what regulators are demanding, Cox said.

    Michael Tilley, who was slammed by regulators for how he operated the Terre Du Lac system before Cox took over, spent most of his life in the community and knows many residents. He said he felt a responsibility to serve them well, but repeatedly faced hurdles finding grant money.

    “I think if I had any claim to fame it was just keeping the rates low and trying to operate this thing on a shoestring,” he said. “I look back a lot of times and that was my problem.”

    Recruitment of professionals to run small water system is also a major issue. The largely white, male workforce is aging, according to surveys.

    Earlier in his career, Tim Wilson, a water project manager, spent time running the treatment plant in Wahpeton, Iowa, a community of just over 400 that expands when vacationers rush in during the summertime.

    Small, rural communities have a “ridiculously hard” time recruiting certified operators, he said. Then once they trained, they can be lured away by better pay and benefits elsewhere.

    The job demands can also be overwhelming. In Wahpeton, Wilson was the lone employee responsible for the treatment plant. He doubled as a snow plow driver and zoning expert at local government meetings. His crowning achievement, he says, was convincing officials to hire another person to help. It took six years.

    Nearly 1,000 miles south in Ferriday, Louisiana, staffing is one problem, but the water has failed people in every major way.

    You know your water is in trouble when it’s being distributed by the National Guard. That’s where residents of Ferriday took their bottles and buckets for four months back in 1999.

    “I haven’t drunk the water since,” said Jameel Green, 42, who has lived in town most of his life. He now makes sure his two girls, ages 16 and 8, don’t drink Ferriday water either, even if it costs $60 a month.

    He held up a garden hose caked with a white film from the water.

    It wasn’t always like this. In the 1950s and 1960s, Ferriday had a vibrant music scene – Jerry Lee Lewis was a local and acts like B.B. King stopped by. Some 5,200 people called Ferriday home. There are about 40% fewer people now, and Ferriday is a mainly Black community. The Delta Music Museum that celebrates the town’s place in music history is surrounded by mostly empty shops.

    In 2016, the water situation was supposed to change. The U.S. Department of Agriculture helped fund a new treatment plant that went into operation.

    But when the company that built the plant walked away after completion, the people operating it were left with little training on how to run it. Staff have struggled to find the right mix of chemicals, according to the Rev. James Smith Sr., who was brought in to help with the issue.

    “That’s the big problem. Everybody is still doing trial and error,” Smith said.

    Ferriday’s water problems represented “a system in total breakdown,” according to Sri Vedachalam, director of water equity and climate resilience at Environmental Consulting & Technology Inc, who reviewed public files.

    Water disinfection in Ferriday is leaving behind levels of carcinogens that are too high. For failing to fix its problems, the state issued Ferriday a $455,265 fine in November 2021.

    Smith said the water is now significantly improved. It’s tested regularly and plant operators are working on new treatment methods.

    But Ferriday never responded to the fine and the Louisiana health department is threatening to ask a judge to impose a timeline for improvements and force payment.

    Without a lot more money and more aggressive intervention in the worst places, experts say many Americans will continue to endure an expensive search for drinkable water, or else they’ll drink water that is potentially unsafe.

    “In my view, this is a desperate problem,” Teodoro said.

    ___

    Phillis reported from Ferriday, Louisiana, and St. Louis. Fassett reported from Seattle.

    ___

    The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

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  • What’s Better for Your Brain, Crossword Puzzles or Computer Games?

    What’s Better for Your Brain, Crossword Puzzles or Computer Games?

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    By Amy Norton 

    HealthDay Reporter

    WEDNESDAY, Nov. 2, 2022 (HealthDay News) — Older adults looking to slow down memory loss might find some help in a classic brain-teaser: the crossword puzzle.

    That’s the suggestion of a small study that followed older adults with mild cognitive impairment — problems with memory and thinking that may progress to dementia over time. Researchers found that those randomly assigned to do crossword puzzles for 18 months showed a small improvement in tests of memory and other mental skills.

    That was in contrast to study participants who were assigned to a more modern brain exercise: computer games designed to engage various mental abilities. On average, their test scores declined slightly over time.

    Experts cautioned that the study was small and had other limitations. For one thing, it lacked a “control group” of participants who did not perform brain exercises. So it’s not clear whether doing crossword puzzles or playing games is significantly better than doing nothing.

    “This is not definitive,” said lead researcher Dr. Davangere Devanand, a professor of psychiatry and neurology at Columbia University in New York City.

    He said that larger studies, including a control group, are still needed.

    As it is, the current results were unexpected, according to Devanand. Going into the trial, the researchers suspected that computer games would reign superior. Past studies have found that such games can help older adults with no cognitive impairments sharpen their mental acuity.

    It’s not clear why crosswords were the winner in this trial. But, Devanand said, there was evidence that the puzzles were specifically more effective for people in the “late” stage of mild cognitive impairment — which may suggest that crosswords were easier for them to manage.

    The findings were published online recently in the journal NEJM Evidence.

    Mild cognitive impairment is common with age, and does not always progress to dementia. But in many cases it does. It’s estimated that among adults age 65 and older who have such impairments, 10% to 20% develop dementia over a one-year period, according to the U.S. National Institute on Aging.

    Researchers want to find ways to delay or prevent that progression to dementia, and mentally stimulating activities are one avenue under study.

    Some research has found that brain games may help people with mild cognitive impairment boost their memory and thinking skills — though studies have found a lot of variation in the types of improvements seen.

    And one question, according to Devanand, is whether any particular types of brain exercises are better than others.

    So his team set out to compare the effects of web-based computer games and web-based crossword puzzles.

    The researchers recruited 107 older adults with mild cognitive impairment and randomly assigned them to either type of brain exercise. All participants received lessons on how to log on and use the games or puzzles.

    Even though the crossword puzzles were online, Devanand noted, they were otherwise the same as old-fashioned paper-and-pencil ones. They were moderately difficult — at the level of a New York Times puzzle on a Thursday.

    After 18 months, the investigators found, the crossword group had improved by about 1 point, on average, on a standard scale assessing cognitive decline — focused mainly on memory and language skills.

    In contrast, people in the games group declined by a half-point, on average.

    Individuals did vary, however. About one-quarter of the games group, for instance, improved their scores by at least 2 points.

    And when the researchers looked closer, the difference between the two brain exercises was specifically seen among people in the later stages of mild cognitive impairment.

    It’s possible, Devanand said, that for older people with more substantial impairments, crossword puzzles were easier to manage.

    An expert not involved in the study said that “limited conclusions” can be drawn from the findings — in part because there was no control group.

    “However, the results open the door to follow-up trials to directly examine the possibility of benefit from computerized crossword puzzles,” said Claire Sexton, senior director of scientific programs and outreach for the Alzheimer’s Association.

    She stressed, though, that it’s unlikely any single measure — crosswords or otherwise — will make a big difference in the progression toward a complex disease like dementia.

    Instead, Sexton said, the greatest potential may be in “multidomain interventions that simultaneously target many risk factors.”

    Sexton noted that the Alzheimer’s Association is funding a trial, called U.S. Pointer, that is testing that possibility. It’s looking at whether a combination of tactics — including physical activity, brain exercises and better control of high blood pressure and diabetes — can benefit older people at increased risk of cognitive decline.

    For now, there is at least little risk to picking up a crossword puzzle habit.

    “We have a saying in this field about the brain,” Devanand said. “Use it or lose it.”

    More information

    The Alzheimer’s Association has advice on protecting brain health.

     

    SOURCES: Davangere P. Devanand, MD, professor, psychiatry and neurology, Columbia University Medical Center, New York City; Claire Sexton, DPhil, senior director, scientific programs and outreach, Alzheimer’s Association, Chicago; NEJM Evidence, Oct. 27, 2022, online
     

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  • Dementia Symptoms Appear Years Before Official Diagnosis: Study

    Dementia Symptoms Appear Years Before Official Diagnosis: Study

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    Oct. 28, 2022 – When Michele Greenfield reflects on her mother Joan’s decline into dementia, the warning signs were there for years: At an awards dinner, where her mother pulled out dental floss and began flossing at the table. Forgetting longtime family friends when her children mentioned them in conversation. The fact that she stopped cooking, something she had long loved. Yet it was several years later before the family could get Joan to the doctor for a diagnosis.

    “We couldn’t get her on board for any testing,” says Greenfield, “and when we finally did, and the doctor suggested she might have dementia, she was furious with him. This was a doctor she had loved and seen for years, but now she was angry with him.” 

    The family’s journey with Greenfield’s mother is common in that receiving a diagnosis of dementia often takes years. In fact, new research out of the U.K. suggests that in most cases, the symptoms of dementia begin as many as 9 years before the actual diagnosis. 

    Using data from the UK Biobank, researchers compared cognitive and functional measures in people who later developed a form of dementia with those who did not. The Biobank is a collection of medical and genetic data from half a million volunteers that’s used to help researchers prevent, diagnose, and treat of a wide range of illnesses.

    “We wanted to see how early we could pick up some of the signs of the diseases,” says lead author Timothy Rittman, PhD, a senior clinical research fellow in the Department of Clinical Neurosciences at the University of Cambridge. 

    “We suspected that subtle signs show up long before they are really noticed.”

    The study involved 500,000 people between the ages of 45 and 69 and looked at their day-to-day functions. 

    “We wanted to look for the meaningful differences between the groups,” explains Rittman. “Once we found them, we wanted to know if they’d always had these symptoms, and whether or not they were getting worse. The closer to diagnosis, the worse they got.” 

    This checks with Greenfield’s experience. As her mother’s disease worsened, other symptoms began to appear. 

    “She’d talk to the television or stick her spoon directly into a container of ice cream, which she never would have done,” says Greenfield. “Then she had some fender benders while driving, and we had to work to get her license revoked.”

    While symptoms become more obvious as dementia progresses, early signs can be easy to reason away – or, in the case of the patients themselves, deny away. But knowing what the early signs might be and acting on them can be important for early intervention. 

    What to Watch For

    Heidi Roth, MD, an associate professor of sleep medicine, memory, and cognitive disorders and a leader at the Duke-UNC Alzheimer’s Disease Collaborative, says that often, people wait until they’re quite impaired before seeking an evaluation for dementia. 

    “This could be a breakdown in their ability to function,” she says. “They struggle to take care of finances, go shopping, are consistently forgetting appointments, and obvious signs like that.”

    Roth says that the U.K. research pointing to a full 9 years from early symptoms to diagnosis makes sense, for a variety of reasons. 

    “There might be slight changes early on, but they probably don’t react,” she says. “Or family members might not want to accept that their loved one is showing signs of impairment, because it can be a big adjustment for everyone.”

    There’s also the fact that everyone has some minor cognitive declines with aging – walking into a room and forgetting why you were there, for instance. Or forgetting the occasional appointment. Even in our 30s and 40s, we might worry about these instances. “But it’s when the behaviors become more consistent, or when people begin to comment on your ‘little misses,’ that you should pay attention,” Roth says.

    Rittman suggests that if you or a family member has concerns about subtle changes, see a doctor for an evaluation. 

    “They can test for logic, fluid intelligence, memory, and thinking,” he says. “There are general signs that will turn up with dementia.”

    Screening can first determine if you are headed toward dementia or if there are other causes for symptoms. In some cases, especially with elderly patients, the issue might be polypharmacy, or using multiple drugs to treat a single condition. Removing one or more drugs from the mix could be all that is needed to clear up some of the symptoms. Screening for – and treating if needed – anxiety and depression can also sometimes lessen dementia symptoms early on. 

    If dementia is indeed the diagnosis, the value in early screening is that there are some lifestyle changes a patient can make that might help. 

    “There’s a lot of evidence that diet and exercise can reduce dementia risks,” says Roth. “There’s also evidence that sleep can play a role in cognitive function. For instance, people with untreated sleep apnea begin to show cognitive decline a full 10 years before others.”

    As clinical drug trials advance, there’s also hope that if the disease is caught early enough, meaningful therapeutics might stop it from progressing as well. 

    “We’re making progress on that front, but we’re not there, yet” says Roth. 

    Rittman agrees and sees his research as a contribution to dementia research and treatment. 

    “The medications are coming along, but we also need to think more creatively on the mechanisms of these diseases, potentially combining medications to attack them,” he says. “I’m hopeful that this trial contributes to the awareness that we need to be looking early on when symptoms appear.”

    After her experience with her mother, Greenfield advises others to act early when they suspect dementia in a loved one. 

    “Don’t wait too long, until the situation gets dangerous,” she says. “It’s helpful to plan for the inevitable, especially if people live on their own.” 

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  • Alone Together: Caregivers and Loved Ones Struggle With Alzheimer’s

    Alone Together: Caregivers and Loved Ones Struggle With Alzheimer’s

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    For a while, Barbara Hebner would grab whatever things she could find, bundle them into her bathrobe, and then tie everything to her walker and head for the door. She wanted to go home.

    Her first breakout attempt happened in 2018. Hebner somehow slipped past her vigilant daughter, Kimberly Hayes Bock, and got as far as the back gate, when a neighbor raised the alarm. The near-escape frightened Hayes Bock – and, as the fear wore off, made her feel guilty. She installed double-sided locks on the doors and a padlock on the gate.

    The runaway phase lasted a few months. Once, during an episode, her mother slammed a walker into Hayes Bock, hitting her hard.

    Now, 5 years later, Hebner still tries doors, but less often, and with less determination. Around 6 months ago, her thinking skills worsened. She can no longer put sentences together that make sense, says Hayes Bock, of Joplin, MO.

    Day after day, year after year, the struggles caregivers face, both big and small, take their toll. Caregiving for a parent is a kind of role reversal: a dark mirror of the nurture and support that once went the other direction. 

    Hayes Bock’s situation is not a rare one; she’s one of 16 million unpaid caregivers in the U.S. But here, there is no strength in numbers. The job itself is so solitary that many struggle alone.

    With a young child, even on difficult days, it’s easy to imagine the happy milestones: the first steps, or the first day of school. Caregivers don’t see a bright future for their loved one – only decline. Alzheimer’s disease and other types of dementia chip away at your dignity and independence, while caregivers figure out how to manage jobs, family obligations, and ever-present guilt and sleeplessness.

    There are moments of grace, like a smile of recognition, or a squeeze of the hand. There are also flashes of humor. Hayes Bock recalls the time she was looking for her mom’s 40-ounce purple bottle, and found it on the nightstand wearing a lampshade. The lamp was in the trash. “We struggle because they have changed,” she says. “The moments of grace come when we realize that a lot of the suffering is ours, as caregivers.”

    Hebner moved in with Hayes Bock in 2016, not long after she was diagnosed with mild cognitive impairment. They tried memantine and Aricept, drugs for moderate to severe Alzheimer’s that can help with confusion and memory loss. Neither drug helped, and the side effects were intolerable.

    Today, at age 80, Hebner needs 24/7 care. She no longer recognizes her daughter, who calls her “Barbara” instead of “Mom” sometimes, because Hebner no longer responds to “Mom” or “Mother.” She needs help bathing, but she can still dress herself, even if she ends up with mismatched clothes and her shoes on the wrong feet. Her habit of ripping the crotch out of her depends and then flushing it once earned a $450 charge from the plumber.

    Hayes Bock recently posted in a caregiver support group on Facebook that she didn’t know what was worse: finding feces on the floor, or being properly prepared to clean it up, because such messes happen so often. Hayes Bock has learned to laugh it off. “It’s the ugly, hard situations that bring out the patience you never knew you had. Those moments when keeping their dignity becomes top priority,” she says. “As caregivers, we are looked at like rock stars. If I can just get us through this with that dignity intact, whether she knows it or not, it will be a win. No rock star here, just a daughter trying to do right by my mom.”

    Over the years, Hayes Bock has relied on paid caregivers to fill in when she couldn’t be around. Fortunately, Hebner’s escape attempts never included wandering at night, so when the house powered down in the evening, Hayes Bock would make sure her mom was in bed, and then lock up for the night. Last January, she was able to rearrange her work schedule to accommodate caregiving. Today she works the night shift, Thursday through Sunday, in her job as a machine operator at a nearby food plant. While she’s working at the plant, her husband takes over caregiving. Hayes Bock gets home from work around 7 a.m. and sleeps until around 11. She’ll check on her mom and feed her if she’s awake. “In these later stages, they sleep a lot. Then I go back to sleep until 3:30 or so and do it all over,” she says.

    Although Hebner is far from catatonic, she sits in a chair all day having conversations with people who aren’t there. Now, she only takes her walker on laps around the house when she’s hungry, sometimes putting cookies in her pocket. Hayes Bock worries about her mom’s nutrition and adds Ensure to her cereal to boost the vitamin count. She recently asked the doctor what comes next, and they talked about difficulty swallowing. She dreads the day her mom stops eating completely.

    “If I get two meals in her, and pants on her, it’s a good day,” Hayes Bock says. “We decided it was laugh or scream. You have to laugh or you’ll lose your mind.”

    Caregivers all over the world could tell the same stories. “With dementia, grief and loss begins before death and doesn’t stop afterwards,” says Karen Moss, PhD, an assistant professor at Ohio State University’s colleges of Nursing and Medicine, and a nurse-scientist who studies dementia in family caregivers. Moss’s work focuses on the anxiety and stress of caregiving, pain, and the end of life of older adults who have dementia. Moss specifically focuses on Black adults with dementia and their family caregivers. 

    Dementia and Alzheimer’s are extremely difficult conditions for the person going through the disease, especially early on as they struggle to figure out what’s wrong, says Moss. And family caregivers struggle too.

    For starters, caregivers have to cope with changes brought on by normal physical aging – like decreased mobility and worsening vision – as well as the anguish of watching the person they love slowly disappear. As they fade, caregivers are left with heavy decisions to make – alone. If, say, a loved one falls, caregivers need to know whether to call the doctor or head to the ER.

    In these scenarios, financial concerns loom large. Was that fall bad enough to head to the ER, which is so much more expensive than urgent care? What if it was the third one in a month?

    As the disease gets worse and people with dementia need more and more help with everyday tasks like balancing the checkbook and paying bills, caregivers need to shift how they manage jobs and family obligations, all the while struggling to create a life that’s calm and happy, says Jason Karlawish, MD, a geriatrician and professor of medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia. 

    There is no cure for Alzheimer’s disease. Three drug trials are awaiting the FDA’s review, but of the more than 100 that have come before, none have had much success. But advocates would settle for less than a cure.

    Even the ability to slow down the disease’s symptoms would be life-changing for many. “I think that’s a vision we have to have in this disease,” Karlawish says. “This idea that we are going to drug our way out of Alzheimer’s and turn it into polio, where all you need to do is get the vaccine and you’re done, is not a sensible position for science policy or for public policy.” 

    Even if a drug manages to affect the disease’s course, the treatment likely won’t be simple – and may need to begin years before symptoms even appear, says Eric McDade, DO, a neurologist at Washington University School of Medicine in St. Louis and principal investigator on a global clinical trial in a group of patients with dominantly inherited Alzheimer’s disease. “I hesitate to get too excited just knowing how difficult these trials are and how surprised we’ve been in the past,” he says

    Moss finds that both current and former caregivers are eager volunteers for clinical trials – especially her projects covering caregiver stress. They also volunteer what information they can on how the disease is affecting their loved ones. “With Alzheimer’s disease and other related dementias or any disease for which there is no cure, people want to feel that there’s a saving grace; many of us want to know there’s something that can help turn around the disease for their loved one.” 

    And they come prepared with questions of their own.

    “Caregivers are super savvy individuals,” she says. “When we approach them for research, they want to know what we are going to do with this information. They ask, ‘How am I going to get the results?’ They want to know, and they deserve to know.”

    Susan Hersey Guilmain learned about her husband’s dementia when she signed them both up for a clinical trial at nearby Butler Hospital. The trial was supposed to test whether a Mediterranean diet could stave off cognitive decline. Neither qualified for the trial. Hersey Guilmain’s diet was already too close to what was being tested, and medical tests showed that her husband Roger already had significant cognitive impairment.

    At first, he didn’t believe the tests. But the team at the hospital reassured him that they could help. “They put a positive vibe on it, so he was OK with going to his doctor and getting further testing and treatment options,” says Hersey Guilmain.

    The Butler team eliminated over-the-counter sleep medications, including Tylenol PM and the three Benadryl tablets he was taking every night. They changed his diet and upped his exercise. Roger started to show improvement. He’s also taking Aricept and the herb Bacopa monnieri. A few months ago, he joined an early clinical trial testing whether Emtriva, an HIV drug that reduces inflammation, is safe for people with mild to moderate Alzheimer’s.

    He was diagnosed a little over a year ago, and he’s still at the stage that Hersey Guilmain, a retired occupational therapist in Smithfield, RI, calls “the funny stuff.” He gets confused; he thought their Dunkin’ Donuts moved, and that someone had changed the buttons around on the microwave. “He actually said, ‘Who did this?’” says Hersey Guilmain.

    She adds moments of calm to their days by making certain they take walks in the sunshine, around the neighborhood or a nearby lake. They also enjoy a cocktail hour every day at 5, sipping either wine or cider. The TV is off and they spend half an hour or so connecting with one another. 

    “Right now, it’s not as intense as it can or will be,” she says. “It’s stuff I can laugh at.” Sometimes, Hersey Guilmain gets frustrated when her husband is uncooperative about brushing his teeth, or when he tells a story that didn’t happen. She reminds herself that this is a disease, and she chooses to make jokes, rather than getting into an argument.

    “It’s not an argument I can win,” she says.

    After caring for an aunt and her mother, both of whom died with late-stage dementia, Hersey Guilmain knows what’s ahead. Even with the spectacular progress Karlawish says the Alzheimer’s field has made in less than 20 years, there’s still very little help for caregivers. 

    Hersey Guilmain says she fights every day to stay positive. “I am not going to think ahead to ‘what if,’ because I can’t,” she says. “I am just doing today, and today is good.”

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